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Get and Sign Pa Form Transfer Care 2014-2022
With Report Zip Pulse Blood Pressure VITAL SIGNS Resp Glucose SaO2 Yes Mental Status AVPU Alert Voice Pain Unresponsive ECG Rhythm 12-lead ECG Interpretation Copy of Rhythm Strip/ all 12-lead ECGs Delivered with Report EMS TREATMENT Medication/ Intervention IV No IV Fluid Type PROVIDER TRANSFERRING CARE QRS Provider NOTES / COMMENTS Dose Size/Location Total IV Fluid Volume Given Oxygen mL CERTIFICATION NUMBER LPM CARE TRANSFERRED TO Receiving Hospital/Agency Name Time of Transfer Receiving...
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